The relationship between neurogenic dysphagia, stroke-associated pneumonia and functional outcome in a cohort of ischemic stroke patients treated with mechanical thrombectomy

Abstract

Introduction Mechanical thrombectomy (MT) is an established treatment approach in acute ischemic stroke patients with large vessel occlusion (LVO). Recent studies suggest that the prevalence of dysphagia and pneumonia risk is increased in this patient population. The aim of this study was to systematically evaluate the prevalence, predictors, and influence of neurogenic dysphagia for 3-month outcome in a large population of patients receiving MT and to elucidate the relationship between dysphagia, stroke-associated pneumonia (SAP) and medium-term functional outcome. Materials and methods Data of a prospective collected registry of patients with LVO and MT between 2016 and 2019 were analyzed retrospectively. Binary logistic regression was carried out to determine predictors for dysphagia and 3-month outcome as measured by the modified Rankin Scale, respectively. A mediation analysis was performed to investigate the mediating influence of intercurrent SAP. Results A total of 567 patients were included in the study. Mean age was 73.4 years, 47.8% of the patients were female, and median NIHSS was 15.0. The prevalence of dysphagia was 75.1% and 23.3% of all patients developed SAP. In the regression analysis, dysphagia was one of the main independent predictors for poor functional outcome at 3 months. The mediator analysis revealed that the effect of dysphagia on the functional outcome at 3 months was not mediated by the occurrence of SAP. Discussion The prevalence of dysphagia is high and exerts both negative short- and medium-term effects on patients with large vessel occlusion who undergo MT.

Early flexible endoscopic evaluation of swallowing after mechanical thrombectomy in stroke patients

“…Both the presence of FEES‐defined dysphagia of any severity and an increasing FEES‐defined dysphagia severity are associated with an increased functional disability, as measured by mRS at 3 months. The current study confirms previous evidence demonstrating an association of dysphagia with functional outcome after ischaemic stroke 2 , 11 , 15 , 38 and also the previous findings by Warnecke et al showing that increased severity of early dysphagia predicted poorer 3‐month functional outcome in a selected population of stroke patients. 39 Our study demonstrates for the first time, that in stroke patients undergoing MT, an increasing dysphagia severity, as assessed by FEES within 5 days of hospital admission, is also independently associated with worse global HRQoL at 3 months.…”

“…respiratory or cardiocirculatory instability, predicted prolonged reduced vigilance, malignant infarct and need for early neurosurgical treatment). Based on our observation of a high frequency of dysphagia in patients with large vessel occlusion undergoing MT, 15 we adapted our criteria for performing FEES in the routine clinical care: beginning in July 2021, we systematically aimed to perform FEES within the first 5 days after admission in every patient undergoing MT, unless there were contraindications, the patient was receiving palliative treatment or the patient did not consent to the exam. FEES was performed in these patients regardless of the result of the initial dysphagia screening.…”